| NPI | 1093069338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 22159) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 12535) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2012-11-08 |